#15 - Quadrant Movement Analysis: Taming the Clinical Grey Area With Dr. Pape, Part 2

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Okay, I know, guys, that was super cheesy, but you get my point. So be sure to check the links in our show notes for both of these special offers. Now let's get back to the show. Factor, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents, serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, Our goal is simple, to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to digest, with actionable information that you can implement into practice right away. Let's get started. Hi guys, welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thanks for listening. In today's episode, we will wrap up our 2-part training titled Quadrant Movement Analysis: Taming the Clinical Gray Area with Dr. Rob Pape. Dr. Rob Pape is a longtime innovator in clinical education and treatment instruction. He created Quadrant Movement Analysis, commonly referred to as QA, which combines a subclassification system with theoretical-practical biomechanics. QA improves and simplifies patient assessment, breaking the body down into traceable patterns that can be utilized to get better and faster patient results. Dr. Pape is a graduate of Life Chiropractic College West and has been in successful practice ever since. His clinical approach is full-body and generally combines joint and soft tissue work with movement therapy. In part 1 of this training, we laid the foundation for the Quadrant Movement Analysis framework that practitioners can use to zero in on where to begin with treatment and to continue collecting data points through reassessment to adapt the treatment approach as the patient progresses through care. Today, we will talk more about the hierarchy for addressing multiple subclassifications. And Dr. Pape will discuss patterns of mechanical dysfunction and how they can lead back to the chief complaint. It's often said that if you don't assess, it's just a guess, and that statement rings true not only in the first visit but throughout the progression of care. As you listen to the final installment of this training, I encourage you to think about your process for assessment and reassessment. How are you using your findings to guide and adapt your approach? As always, please be sure to submit any of the questions that might come to mind as you're listening today through the Q&A link in our show notes. We always invite our instructors back on for a future Q&A episode where we'll cover all of your burning questions. Let's dive into today's training.

Here is one schematic. We've got a bunch of these schematics that will come with the coursework of the normal dysfunction patterns. Quadrant Analysis talks about short muscles versus long muscles. Now, in physical therapy they talk about tight muscles versus weak muscles. For me, a tight muscle can be weak. Any muscle can be weak. A short muscle can be weak. A long muscle can be weak. It depends on where you're testing it, how you're testing it. The length you're testing it at. So I like short and long. Short and long give me something that's actionable. I can play with short and long. If I need to stabilize rotator cuff neck issue here on the right side, this green here, these are long muscles in my world, generally speaking. And if I find that on evaluation, I'm going to treat that differently than if I saw a similar presentation on the opposite side, on the left side, where there are short muscles. This is some of how we define mechanical dysfunction in quadrant analysis. Directional tissue tension is if I palpate the tissues against that arrow, they're probably going to be more restricted and push back at me more in that direction. So this is normal dysfunction. Abnormal dysfunction for a pattern break would be I'm seeing something short. I see short muscles at the front of the right shoulder, let's say for Apley's 1, and short muscles on the back of the shoulder for Apley's 2. So Apley's under, Short on the right, Apley's over, short on the right. That's a pattern break in my world potential. It at least gets my antennas up. After that, hypermobility. We're not going to go into this one too deeply. If you do not know what hypermobility-related disorders are, you best learn because your practice will have these folks. Chronic musculoskeletal problems, they're constantly looking for answers. You need to know about the fact that this is genetic, about the fact that there's Potentially a lot of different subtypes of hypermobility. You need to know about how to evaluate for a Beighton score. There are a million little things. We're not going to go into them here. That's in the coursework. Abdominal is our systemic inflammation subclassification. And we call it abdominal in Quadrant Analysis because— I figured this out because I started to read books about abdominal evaluation, abdominal massage, organ massage, and whatnot. And what I found was that People who were systemically inflamed, whether it was acute or chronic, right? If I palpated their abdomen, I would get clues and these clues would lead me to be able to have a conversation with them about what's going on in their life and with their lifestyle, with their diet and their stress and their sleep and other things. So the 2 classic presentations are somebody comes in and they've got neck shoulder pain. It's Monday and they're like, man, doc, Oh, I don't know. I woke up this morning. I can't even turn my head. And you go to evaluate them and they are just super tender. Like you're not even sure you're going to be able to get in there on their neck and shoulder. Well, you go to evaluate their abdomen and especially in this classic case, that right upper quarter where their liver and their gallbladder is sitting is on fire. And they jump when you palpate underneath the softer tissues, the muscles. And then you find out they had a weekend of debauchery. Okay, well, I don't necessarily need to try to get in there and adjust you right now. I need you to go home and eat really well and clean yourself out for a couple of days, and then you come back in a couple of days and we'll see what's left. And then the other classic presentation is more of a centralization, autoimmune disease, IBS, all the different fibromyalgia, chronic fatigue type presentation. Those folks tend to be really tender in most of their abdomen. What I like about using the abdomen is It clues them into the fact that whatever they've come to you with, whether it's headaches or low back pain, knee pain, whatever it is, they start to go, oh, well, you mean my diet or my sleep or whatever it may be, may be part of this? And because they've already been to 100 other people, right? And people have tried to clue them in. And sometimes this is what they need to hear to change things up a little bit and to make the right changes for themselves. Dynamic stability or motor control, which I kind of use interchangeably, probably to my detriment. If your muscles can't hold your joints together, well, the body's going to create some scaffolding, you're going to have some mechanical dysfunction and subluxations. And if you're just going around pounding on the high spots without having evaluated whether this person can hold themselves together, at least on some minimal level, you're going to keep cracking away, and you're not going to get anywhere, you're going to go 2 steps forward, 2 steps back. So motor control, this seems pretty basic to me. But a lot of chiropractors don't evaluate for this. And I've And I know why. And so again, pattern schematics. What's the deal? What's the deal with them? So these flexor-extensor patterns represent— this is something that they talk about in the Diplomate in Neurology program. I took like over a year of that when I was back in school, and I didn't understand it then. I didn't really— didn't start to understand it until about maybe 12, 13 years ago when I really started to see it in practice every day. But the people who are smarter than me in that world, who I trust, who are really well-educated and evidence-based, they describe this It happens in embryology where there's a turning of the body in such a way that we see these quadrants develop, this resting muscle tone distribution develop along agonist and antagonist lines. We see it in this spiral sort of way. When you read books by old-timey bodyworkers, they talk about the body twisting and turning in, out of alignment, back into alignment, peeling away layers of the onion, blah, blah, blah, blah, blah. We are rotational creatures. Everything we do involves rotation. So spiral patterns are part of this, big part of it, underlying part of it. One of the ways I think about the flexor-extensor-short patterns are like a serape. So if you know about the serape effect, imagine it out of balance from one side to the other, and then imagine what the rest of the body does with that trunk malalignment. That's kind of what we're looking at here. Imagine that serape going across the shoulder to the hip and back around. Let's say it's shorter on the right side going from the anterior part of the body, from the right shoulder to the left hip, pulling that right shoulder towards the left hip on the anterior side. This is what you'd get because the opposite side would be long. We'd have a short side and a long side. This is what it would look like, generally speaking. And then this is a little more advanced, so we're not going to get into it, but we see a sort of— in the lower extremity, it's a little more complicated. A lateral subsystem develops, but we're not going to go into that so much. So we have these patterns, but people say, and people are right, we all move differently. We all have different mechanics. We do. Underlying is this neurological resting muscle tone distribution that can get out of balance. But on top of that, yes, we all have different genetics. So we all have different lengths of our bones. Our muscles are slightly different angles. We have different use patterns. We have different injury histories, which is why it's important to have a thorough evaluation. Yes, everyone's different, but everyone's the same underneath to some extent. That helps us. That gives us a sort of guide rails. within this thought framework to evaluate mechanics. So again, ideally this tone is in balance. And not to get philosophical on you, but the founder of the chiropractic profession did mention the fact that tone was his major checkpoint, right? So when he was evaluating someone, he was looking for changes in tone to describe whether he was getting people where he wanted them to be. And there's something to that. There's absolutely something to that. I had mentioned this previously. These flexor-extensor patterns are normal responses to different types of stress. This is a schematic that is in the packet as well. We see, and this is very pain science oriented, but I learned this way back in school back in the '90s. There's different types of stress that when they overload the system, the body, almost like a fuse being switched, the body mechanically deforms. We get these patterns. In effect, that creates some tissue stress. Tissue stress theory is something really cool. Actually came out of podiatry, as far as I know. David Wedemeyer turned me on to it, but it explains a lot of what we see. So tissue stress from this mechanical dysfunction, from this stress overload, which again, now we're looking at lifestyle stuff, right? Really important, but leads to pain in some people some of the time. Pain is a stress overload message. The patterns, back to the patterns. So it gives me an idea of what I'm looking at, and I might need to use different parts of the body to affect change. If I want to affect change on the right shoulder, I might need to change mechanical situations up or down the chain. So again, predictable joint by joint. I would expect to see these things. If I don't see these things, well, that's data that might be actionable for me. And again, from a treatment standpoint, I have all kinds of possibilities, whether I'm trying to stabilize, whether I'm trying to load, whether I'm trying to mobilize. Whatever it is you do, whatever your unique abilities are, you can apply them in a lot of different ways if you understand these concepts. And you can do it up and down the body and test, treat, retest to see if you've made the changes you want. So back to pattern breaks. What if we see something out of pattern? We're looking at probably packed, packed, probably where pain just went away, and possibly the villain, not the victim, the villain, right? Because there's no pain there. This person has no pain in that place. How do we find that? Well, we evaluate. We move them and we feel around. We got our hands. Don't forget your hands. I know a lot of us are great movement therapists, but you can learn a lot with your hands too. And if you just use your hands, learn to use your eyes. You got to be able to see movement. We've got to be able to feel movement. And there's the how we do it in Collateral Analysis again. And you, again, fungible. You can do it your way using the concepts. And here is sort of like the giveaway. Here's— I'm going to give you a couple of things you can play with right off the bat. Common pattern break villains that we see. On the same side of the body, we mentioned this one earlier. Apley's 1 and 2. If you see Apley's 1 and 2 restricted or diminished on the right side of the body, Versus the left, both of them, well, you might want to pay extra attention to that right shoulder. That right shoulder might be driving the low back pain or the neck pain that this person's brought in. Straight leg raise and either Faber or supine pushing the knee into the chest on that same side. If you see those 2 things together, you might want to pay attention to the hip knee on that side. And then Faber and Fader. You're asking the hip joint to open in 2 different directions. If they're both restricted on one side of the body, Pay attention to it. You might have some buried treasure there. That's with movement. Now with palpation, same side of the body. Ankle inversion and eversion are big ones. You see that on one side of the body, you want to pay attention to that. Now I'll throw you this one. On the opposite side of the body, is it possible that there's just a loss of stability on that side completely in both directions versus the restricted side? Yes, it is possible. So we're not cookie-cuttering these things. We're The data gives us more questions. It's not too easy, right? But in general, you want to pay attention to these things. If you see that the jaw is retracted on one side and you have your patient supine passive cervical rotation, they're supine and you rotate their head passively to the same side and it's restricted to that side, you want to pay attention to that. And then if they're prone and you're palpating their SI from P to A and then their femur head from P to A, And they're both restricted more on one side than the other, that's another possible villain. That's another possible pattern break. So again, here they are for the movement. Apples 1 and 2, SLR, and either Faber or knee to chest, Faber and Fader. And then with palpation, the ankle in both directions, inversion, eversion, the jaw retracted, passive supine rotation, and SI joint, femur head both being palpated from P to A in the prone position. All right, so that gives you a little bit of action that you can play with. I think we've hopefully touched on these learning objectives. Hopefully you understand a little bit more of what we were trying to get to. We've got some units with Southeast Sports. If you want to look at those, cool. I hope you do. I think this is good stuff and I think it'll help. I've had practitioners who are 30 years in practice telling me that this ties things together for them. It plugs holes. It gives them stuff that's actionable. So check it out. You can also check out practicemechanics.com, which is where I have the rest of this stuff. So I've got like maybe 40 or 50% of it with Southeast Sports right now, and then I've got a bunch more of it with Practice Mechanics at this point. And you can shoot me emails here if you have questions.

Today's episode is brought to you by Southeast Professional Education Group. Formerly known as Southeast Sports Seminars. For over a decade now, we've been pushing the envelope to raise the bar on professional continuing education within the healthcare space. If you like what you hear in this episode, I encourage you to continue your learning with Dr. Pape's virtual Quadrant Analysis of Movement course. This curriculum combines a subclassification system with practical biomechanics to simplify patient assessment. In this course, you'll learn to break the body down into traceable patterns, which you can then utilize to build a successful treatment plan. CE credit is available for chiropractors and physical therapists in many states. Please visit online.sports-seminars.com for details or visit the sponsor link in our show notes.

So that's it for me. I hope this was good. I guess I'll be fielding questions now. Yeah.

Thank you so much, Dr. Pape. Now let's dig into a few different questions. that we've received from our audience. Do you have a case example that you can discuss and walk us through that shows how quadrant analysis fits into your normal examination and assessment process?

I had a patient referred to me recently from a physical therapist I know who's brilliant, movement therapist. Chronic, recurrent, episodic low back pain, 51-year-old female, slight, a mother of 2, Sits behind a computer all day, sort of journalist slash social worker career. Anyways, he's telling me he can't progress her, he can't load her, everything flares her up. So immediately I'm thinking, well, maybe systemic inflammation, right? Maybe she's got some sort of abdominal thing going on here, especially when I think slight and I'm thinking woman. Well, potentially, maybe not at 51, but earlier, maybe she was hypermobile. And hypermobile is going to be sort of like a Very unique combination of motor control/abdominal, to be general about it. Obviously, she has motor control issues. He can't even load her. So I don't need to evaluate her for that. He's— and he's better at it than I am. I'm not going to redo what he's doing. And he says to me, he goes— and I trust him— he's like, I feel like there's a lot of neural tension here. And when I hear a physical therapist say neural tension, I'm thinking chronic mechanical dysfunction. So the evaluation with her Is I know I'm going to find mechanical dysfunction in her low back and hips. But I'm trying to figure out what I'm going to find in the rest of her body, right? She's had plenty of treatment. And she does say that in the past, whenever she experienced low back pain, she'd go and do Pilates a couple of weeks and it would just go away. She'd build up stability and it would just go away. This time it's not working. She's 8 weeks into it and it's— nothing's helping. So in evaluating her, I am looking for joint and soft tissue function, not only at the area of chief complaint, but up and down the chain, right? And I find some— the first thing I found was at her knee. And it turns out that she had fractured her tibia pretty badly in a skiing accident as a teenager. She didn't mention that on her history form. So in the beginning, I was— because actually her movement was, in terms of her range of motion, was excellent. So she might have been hypermobile at one point. She had amazing mobility for someone who was in so much pain, right? Classic hallmark of hypermobility. She also, though, had this injury with her leg. So her neck mobility was fantastic too. But she had chronic neck and— after evaluating— chronic neck and upper extremity, what she called carpal tunnel syndrome, which wasn't carpal tunnel syndrome, was more like a chronic repetitive strain of her wrist tendons. So she had upper extremity stuff and lower extremity stuff. And in evaluating her, what I ended up finding, but again, that she did not put on her history form, was that— Her neck and jaw on the right side, that pattern break I described at the neck and jaw, she had on the right side. And she had in her occipital region, she had all this scar tissue and had like with these grooves that were cut in. And when I found that, I asked her about it. She goes, oh yeah, I had like 10 surgeries there for growths in my ear when I was a kid. I had these chronic ear infections, which again should clue you in, right? Chronic ear infections, you're going to have Chronic vestibular issues. Also, she has vestibular issues that she did not put on her intake form. Anyways, four or five sessions in addressing mostly the neck and the skull and the jaw, and her low back is stabilized, and she's able to start progressing with training. So hopefully, that's from a mechanical standpoint that shows you I'm looking up and down chain. I'm looking at these pattern breaks potentially, and I'm thinking about the sub-classifications as I do it. I hope that's helpful.

As healthcare practitioners, you're often faced with patients that might have chronic pain or be a little bit more sensitive when it comes to even light touch. How do you apply quadrant analysis when you're evaluating or assessing someone that has fibromyalgia, for example?

Well, those folks are very difficult for all of us, but with them, from an abdominal standpoint, and this comes out of pain science even, People who are tender in many, many places are centralized, right? If I can tie that into their gut, if they can feel— and I can think of one patient I have, I can think of a bunch of them that are in that sort of fibromyalgia world in terms of their diagnoses— and I can clue them into their gut and how painful their gut is to be palpated, they are more motivated to make changes in their lifestyle. Now, I might not be the right person to guide them through that, I've surrounded myself with practitioners who run in lanes that are different than mine, that maybe we overlap some, but my expertise in those lanes like diet compared to a registered dietitian, what I know is a drop in the bucket, right? So depending on the patient and depending on how motivated they are, depending on how much they know about their own condition, very oftentimes though, what they know is that if they stick to a certain regimen, They get better. Maybe they're not gonna be perfect, but they get better. They go from being that 8 or 9 outta 10, that screaming pain that they bring in, to that tolerable 2 to 3 or 4 pain because they tweak a few things. And sometimes using abdominal palpation with those patients, it's the baseline for them where it's like, okay, well, you're back in my office. Last 2 times you were in my office, we palpated your abdomen and clued you into the fact that you were off your diet. All right, let's see what we've got here. Now, also, I'm going to be evaluating their motor control and seeing, can they stabilize themselves? And if they can't, we're going to start them on basic motor control stuff and then try to get them on a treadmill or to get their aerobic capacity up. But if trying to get their aerobic capacity up triggers them, well, it's probably because they have a motor control or a dynamic stability deficit. And we hopefully have evaluated for that to begin with. So we've cut that off at the pass.

When practitioners look at systems of assessing patients or evaluating a patient the first time, doing their initial exam, they kind of look at it in 2 different buckets. So do you consider quadrant analysis a system of analyzing dysfunctional movement as it relates to structural or medical diagnoses?

Both. If you're evaluating movement and the structure goes along with the movement, right? I mean, it's you have muscles that are short on one side of a joint versus long on the other side of the joint, you're going to feel something different and you're going to see something different potentially depending on the genetics of the person. And knowing that might give you an idea of why the tissues at that particular juncture where the medical diagnosis is, whether it's a meniscus injury or a capsular injury, whatever it may be, why are those tissues stressed? So the stressed tissues tell you are the medical diagnosis. Right? So the medical diagnosis is often just defining the tissues that are feeling the pain, that are expressing the pain, the pain generator. How did the pain get there? Why is the pain there? What stresses mechanically, but then also physiologically and lifestyle-wise created that stress at that location? So it's both.

When it comes to performing quadrant movement analysis, do you find that most people end up in one classification system, or are people usually kind of spread along a spectrum with multiple different subclassifications?

Oh God, I love that question. Almost always. I mean, you can find mechanical dysfunction on almost anybody you pull in off the street, right? So if that's one of your sub-classifications, yeah. I mean, most people are going to have more than one. There's going to be some overlap for, I would say, at least 50% of people. They've got a little bit of abdominal, they've got some mechanical dysfunction, they've got some motor control. You have to— the doctoring comes in trying to prioritize those, evaluate them, treat them, reevaluate them, and then switch things up on the fly if you're not getting the results you want. So yes, you can see multiple subclassifications with the same person, and the hypermobility subclassification itself is inherently like multiple subclassifications.

So this kind of follows along with that same question. When you do have a patient that has multiple subclassifications, Do you have a specific hierarchy you follow for how you address those, like one that you do before the other, so to speak?

Well, it depends on the data that I've collected, right? It depends on what's come in. It depends on the subclassifications themselves. In the chart that I pulled up about the middle where it was a flowchart and then the subclassifications were along the bottom, that's generally how I do it. But I usually put pattern breaks first. For me, pattern breaks might explain why somebody is experiencing motor control problems. A pattern break is something that the body has decided to accept. It's like there's a contract that's been written and the rest of the body is going to have to adapt and compensate for this pattern break. So I usually put that first, but not always. If I see a pattern break in somebody who's hypermobile, do I address the pattern break before I start to address the different aspects of their particular hypermobility-related disorder? Maybe, maybe not. Depends on how much pain they're in, depends on their goals, depends on how much time I have with them. So it's, again, it's fungible. I have to make decisions in the moment based on the available data that I have. But generally speaking, on that chart is— that schematic is how I tend to. It's not a rule, it's sort of a suggestion.

Going back to the case study that you discussed earlier, you mentioned that you discovered scar tissue in her cervical spine during your analysis. Do you often find that QA helps you discover more things that your patient may have factoring into their chief complaint that they may have left out during their intake or your initial history?

100%. To me, that's the fun of it. Like, if you wanna start in the area of chief complaint and work your way out, cool. If you're getting good results just using a cookie cutter, cool. If you're using a cookie cutter protocol at the area of chief complaint and you get everything you need, awesome. But if you don't, you're gonna work your way out hopefully and look for other issues that might be driving the chief complaint that comes in. So quadrant analysis is sort of the summation of my desire over the years to get ahead of that as quickly as I could so that I could within— and I tell my people when they come in, I'm like, I'm gonna try to within 3 visits have this on lockdown. I wanna know within 3 visits, If I can help you or not. That's just the way I practice. That's me being competitive with myself. And it doesn't mean that I'm done with them in 3 visits. It might— for some people, that 3 visits is the beginning of another 10 or 15 or 20 other visits, depending on what we're doing. I might be done with them after 1 or 2 visits, right? But yes, given that— and Dr. Faye, who has to be one of the smartest people this profession's ever seen, he says the body is a closed kinematic system. Everything affects everything else. Now, how much everything else in this case away from the area of chief complaint affects the area of chief complaint, it's going to be different from person to person. But I want to know upfront, and it only takes me a few minutes to figure out, to screen, to see, is there anything gross that I might be missing? I don't want to discover it on session 4 or 5. I want to see as quickly as possible if I can just in the next few minutes discover whether there's something, a thorn in the side of this person that I'm not seeing, that they don't even know is there, that might be buried treasure, that might be the linchpin to solving this person's puzzle. So yeah, definitely.

Thank you so much for this training, Dr. Pape. This has been incredibly informative. I think I may want to go ahead and wrap up here with a final question that has been submitted from some of our listeners. And that is, oftentimes practitioners, both as students while they're going through school and then after school in continuing ed programs, There are a plethora of different movement assessments to choose from, different methods for analyzing, evaluating patients that they learn or that are out there as options. How is quadrant analysis different from these other movement analyses that are currently being offered?

That's a good question. I don't know. I'm not an expert in other movement analyses. I've taken SFMA, just the first SFMA course. Interesting stuff. It was over my head, quite honestly. But I love Gray Cook and I love those folks who do that work, the SFMA work. So I don't know. That's a really good question. I utilize McKenzie concepts. I utilize McGill concepts. I'm not just using QA. QA is an aspect of what I do. So I don't know. I don't know how it compares and contrasts. I don't know if anybody knows that yet. It'd be cool to be able to play with that. I'd love to be able to chop that up with some people side by side, but honestly, I don't have a good answer to that question. It's unknown or TBD at this time.

Dr. Tate, thank you so much. This has been a very informative webinar, and we really appreciate you taking the time today.

It has been my pleasure, 100%. Stay safe, everyone.

That's all for today's episode. Be sure to tune in for episode 16, where we kick off a new 2-part training with Dr. Spencer Lindholm titled, It's Not Carpal Tunnel, Now What? The median nerve is one of the most commonly entrapped peripheral nerves, and while many providers are able to recognize and diagnose a median nerve entrapment, most fail to accurately diagnose the location of entrapment. Instead, any median nerve entrapment or symptoms are diagnosed as carpal tunnel syndrome, or CTS. In this 2-part training, we will discuss how to differentiate between multiple entrapment sites of the same nerve and how to progress with active treatment and rehabilitation. You won't want to miss it! Episode 16 drops in 2 weeks, or 1 week for our Patreon subscribers. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Give us a 5-star rating to help us grow the show. Every little bit helps. And last but certainly not least, please be sure to visit the show notes for a link to download the PDF of our full presentation from today, as well as more information about Dr. Pape's Quadrant Movement Analysis online course. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-O-R.com. To find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.